Clinical and Experimental Hepatology最新文献

Aim of the study: Non-alcoholic fatty liver disease (NAFLD) is one of the most important causes of chronic liver disease (CLD) in both Western and Asian populations. There is wide inter-individual variability in the occurrence of NAFLD and progression to non-alcoholic steatohepatitis (NASH) even after correcting environmental factors, and its true explanation can be provided by heritability. Two such genetic variations, the glucokinase regulator (GCKR) and membrane bound O-acyltransferase domain containing 7 (MBOAT7) genes, in NAFLD patients were studied in the Indian population.

Material and methods: A cross sectional analytical study was conducted in the Department of Gastroenterology at a tertiary care centre. In total 100 subjects in the age range of 18-65 years were included in the study; 50 were patients with NAFLD including fatty liver, NASH and NASH related cirrhosis, and 50 were healthy subjects (No NAFLD). The polymorphisms rs780094 and rs1260326 for GCKR and rs641738 for MBOAT7 were determined using PCR followed by the PCR-RFLP.

Results: GCKR rs780094 minor allele A was more common in NAFLD patients (p = 0.00001). Within the spectrum of NAFLD, the A allele was present frequently among cirrhotics as compared to NASH and fatty liver (p = 0.00001). Morbidly obese individuals showed significant association with the homozygous A allele (p = 0.028). These results were not seen with GCKR rs1260326 across all alleles. In MBOAT7 (rs641738) the frequency of the minor allele T for NAFLD was 84% vs. 80% in healthy subjects (p = 0.79). The association of the T allele among the spectrum of NAFLD was not statistically significant (p = 0.79).

Conclusions: GCKR genetic variant rs780094 was found to be significantly associated with NAFLD. The MBOAT7 (rs641738) genetic variant was not found to be significantly associated with NAFLD.

Aim of the study: Texture analysis derived from computed tomography (CT) involves quantitative imaging parameters characterizing possible valuable associations with clinical purposes. Their prognostic capability in patients undergoing percutaneous CT-guided liver biopsy to identify associations with postinterventional bleeding complications and biopsy success is not sufficiently explored.

Material and methods: Three hundred fifteen patients (124 female, 39%) with a mean age of 62.5 ±10.2 years underwent percutaneous CT-guided liver biopsy and were analyzed regarding clinical, procedure-related, and CT texture features.

Results: Thirty patients (9.5%) presented with bleeding after biopsy (including two requiring interventional treatment), whereas 46 patients (14.6%) had negative biopsy successes. Distance of lesion from liver capsule was statistically significantly different in patients with and without bleeding (p = 0.015). Several texture features were statistically significantly different between the groups, S(0,1)SumAverg having the highest significance (p = 0.004). Regarding unsuccessful biopsy results, liver fibrosis was the only clinical feature with statistical significance (p = 0.049). Only two texture features (S(4,-4)InvDfMom and Teta3) were statistically different between the groups according to the biopsy result.

Conclusions: Several CT texture features of the target lesion and the length from the capsule to the lesion were associated with bleeding complications after CT-guided percutaneous liver biopsy. This could be used to identify patients at risk at the beginning of the procedure.

Aim of the study: To assess the serum level of Mac-2 binding protein glycosylation isomer as a potential biomarker for hepatocellular carcinoma (HCC) in hepatitis C virus (HCV) cirrhotic patients.

Material and methods: Ninety patients were separated into two groups for the current research. Group I consisted of 45 patients with HCV that resulted in liver cirrhosis but no HCC. Group II consisted of 45 patients who had HCC and hepatic cirrhosis caused by HCV. Each patient underwent a complete clinical examination, thorough history taking, and laboratory tests, serum Mac-2 BPGI, abdominal ultrasound and triphasic computed tomography (CT) of the liver.

Results: Serum Mac-2 BPGI was significantly higher in group II than group I and was statistically significantly higher in patients with portal vein invasion and in patients with lymph node metastases than those without, there was a statistically significant difference between mean values of serum M2BPGI, the BCLC score was higher in group C, and also a significant positive relation between tumor size and serum M2BPGI was found.

Conclusions: Serum Mac-2 BPGI can be used as diagnostic and prognostic markers for HCC.

Aim of the study: Metabolic associated steatotic liver disease (MASLD) is one of the most frequent chronic liver diseases in the world; macrophage activation is reflected by increased expression of CD163, which sheds as serum soluble CD163 that is linked to hepatic steatosis, inflammation, and fibrosis. Aim of the study was assessment of liver macrophage activation and hepatic histopathological changes in patients with MASLD.

Material and methods: A total of 30 patients with MASLD and equal numbers of age- and sex-matched healthy controls were enrolled in the study. Quantitative serum levels of soluble CD163 (sCD163) were determined using a commercially available standard sandwich ELISA kit. Core liver biopsies were obtained from patients with MASLD and evaluation of CD163 using anti-CD163 Ab-1 (Clone 10D6) - mouse monoclonal antibody.

Results: The median sCD163 level was significantly higher in patients with MASLD compared with healthy controls. It can discriminate patients with MASLD from healthy controls at a cut-off value of 814 pg/ml. sCD163 level and intrahepatic total CD163-positive cell count were positively correlated, and both showed positive correlations with nonalcoholic fatty liver disease activity score.

Conclusions: Soluble CD163 can discriminate MASLD patients from healthy controls after the exclusion of other causes of inflammation.

Managing patients with liver cirrhosis and gastric hyperplastic polyps (GHPs) is challenging. Despite being the standard technique for resection of GHPs, hot snare polypectomy (HSP) is risky in the setting of coagulation disorders associated with liver cirrhosis. The aim of the study was to assess the efficacy and safety of endoscopic band ligation (EBL), compared to HSP in resecting GHPs in cirrhotic patients. One hundred consecutive adults with liver cirrhosis and sessile or pedunculated GHPs were enrolled from December 2018 to December 2020. Cases were non-blindly randomized (1 : 1) to two groups to have GHPs managed by either EBL (group I) or HSP (group II). Data of demographic, clinical, and pathological factors, hospitalization expenses and outcomes of both treatment maneuvers were collected and statistically analyzed. Upper endoscopy was repeated for all patients at 3, 6 and 12 months after treatment for recurrence detection. Between the two procedures, the mean operational time was significantly shorter in the EBL than the HSP group (15.1 ±3.80 min vs. 36.6 ±6.72 min, p < 0.001). Concerning complications, 94% of EBL cases had reported no complications compared to 78% with HSP. Bleeding occurred only with HSP (20%) with urgent need for adrenaline and/or argon plasma coagulation (p = 0.003). Regarding cost, it was significantly lower in EBL than HSP (280 ±2.02 EGP vs. 390 ±181.8 EGP, p < 0.001). However, the recurrence rate of GHPs and number of needed sessions were not significantly different. EBL proved to be a safer, more rapid, and economic maneuver when compared to HSP on resecting GHPs in patients with liver cirrhosis.

Aim of the study: Hepatitis delta virus (HDV) causes the most aggressive and rapidly progressive form of viral hepatitis. However, detailed data about epidemiology and risk factors in Polish population are still lacking. Thus, the aim of this retrospective study was to determine the prevalence of HDV infection among a Silesian population of patients infected with HBV.

Material and methods: 177 patients with confirmed hepatitis B virus (HBV) infection were examined for HDV infection. The diagnostic methods used in this study were measurement of HDV antibodies and HDV antigen levels. A telephone follow-up of patients who tested positive indicating HDV infection was conducted, in which they were asked about their current health status, the course of HDV infection and possible risk factors.

Results: The prevalence of HDV infection was 3.4%. Four of six patients already had an advanced level of liver fibrosis (F3 or higher) before starting treatment, one of them having undergone liver transplantation. Alanine aminotransferase (ALT) levels in HDV patients were above normal in half of the cases. Except for two cases, no risk factors were identified that may favor HDV infection.

Conclusions: Hepatitis D is a serious disease that requires more attention. Due to the limitations of our study, larger-scale studies answering the question of the prevalence of HDV in Poland are needed.

Aim of the study: To investigate whether serum ferritin and vitamin D levels before starting autoimmune hepatitis (AIH) treatment have a role in disease prognosis regarding a therapeutic response.

Material and methods: The prospective study included 100 children diagnosed with AIH according to simplified criteria for diagnosis of AIH. They attended the Pediatric Hepatology Department, National Liver Institute, Menoufia University. The patients underwent measurement of liver transaminases before starting AIH treatment after 6 months from starting therapy. They underwent liver biopsy before starting treatment for proper diagnosis, grading, and staging; only 25 cases were compliant and underwent liver biopsy before treatment withdrawal.

Results: Serum ferritin and 25 hydroxy vitamin D levels were significantly higher among those with a complete response (1000-3100 ng/ml, 29-48 ng/ml) than a partial response (550-600 ng/ml, 23-28 ng/ml) and non-response (29.28-92.14, 2.16-8.72) (p < 0.001).

Conclusions: Our study showed a relation between serum vitamin D before starting AIH treatment, the severity of AIH and response to therapy. This opens a new area of research on the potential use of vitamin D in patients with AIH. Also, hyperferritinemia at the diagnosis can predict the treatment response.

Aim of the study: To evaluate single nucleotide polymorphisms of the adenosine triphosphate (ATP) binding cassette subfamily B member 11 (ABCB11) gene, rs11568364 and rs2287622, as potential predictors of hepatologic complications during Epstein-Barr virus (EBV) infection among children.

Material and methods: The study group consisted of 54 children aged 1 to 18 years hospitalised from 01.12.2018 to 31.12.2020 in the Department of Paediatrics, Infectious Diseases and Hepatology with hepatological complications in the course of serologically and molecularly confirmed EBV infection. Real-time PCR using TaqMan probes was used to determine single-nucleotide variability in the ABCB11 gene.

Results: It was found that the presence of the T allele for the rs2287622 marker increases the probability of hepatitis three times and the possibility of hepatitis with cholestasis almost four times in EBV-infected patients.

Conclusions: The rs2287622 polymorphism of the ABCB11 gene appears to have an impact on the occurrence of hepatological complications in the course of EBV infection in children.

Aim of the study: The current updated meta-analysis aimed to explore the effects of vitamin D supplementation on various parameters in patients with non-alcoholic fatty liver disease (NAFLD), using the latest trials available.

Material and methods: PubMed, Embase, and the Cochrane Library were screened for the collection of randomized controlled trials (RCTs) that compared the efficacy of additional vitamin D vs. the placebo group on NAFLD patients in the last 5 years. Trials included were focused on the assessment of anthropometric and biochemical indices.

Results: Our results revealed that additional vitamin D greatly increased serum 25-hydroxyvitamin D (25(OH)D), and decreased the low-density lipoprotein-cholesterol (LDL-C) levels. However, no significant differences were found in terms of triglyceride (TG), total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), c-glutamyltransferase, fasting blood glucose (FBG), homeostasis model assessment of insulin resistance (HOMA-IR) and Ca²⁺ levels between the supplementation of vitamin D and placebo.

Conclusions: The present study demonstrated the advantageous impact of supplementary vitamin D on the levels of 25(OH)D and LDL-C in NAFLD patients. However, the results failed to provide evidence for the superiority of additional vitamin D in relation to the concentrations of serum ALP, AST, TC, Ca, γ-glutamyl transferase (GGT), TC, FBG, IR and HDL-C.

Aim of the study: The aim is to summarize the effectiveness and safety of genotype-specific and pangenotypic hepatitis C virus (HCV) treatments in patients with renal failure.

Material and methods: In the EpiTer-2 database, which includes data from 22 hepatology centers in Poland, 593 patients with HCV infection and kidney failure were identified. According to KDIGO 2022, they fulfilled the criteria of chronic kidney disease. Patients were divided into two groups: treated with genotype-specific regimens (n = 428) and pangenotypic options (n = 165), in relation to the stage of kidney disease determined using the glomerular filtration rate (GFR) (Cockcroft and Gault equation). Two separate groups were created for hemodialyzed patients (n = 134) and patients after kidney transplantation (n = 89).

Results: In a total of 593 patients, 78.7% were treatment-naïve and 23.9% had liver cirrhosis, in 27.5% of cases decompensated. In both groups, the dominant genotype was GT1b. Among patients treated with genotype-specific regimens, LDV/SOF ± RBV, OBV/PTV/r + DSV ± RBV, and GZR/EBR ± RBV treatments were given to 31.5%, 31.5%, and 34.8% of patients respectively. In pangenotypic regimens, GLE/PIB was chosen in 50.3%. Ninety-six percent and 98.8% of patients in the genotype-specific regimen and 88.5% and 94.8% in the pangenotypic regimen achieved a sustained virologic response at 12 weeks (SVR12) in the intention-to-treat and per protocol population respectively. Liver cirrhosis was identified as a risk factor for virological failure. During the study, 14 patients died, 7 in each of the two groups, none related to the antiviral treatment.

Conclusions: Both types of treatment regimens are equally effective and safe in patients with renal failure. The stage of renal failure or transplant does not influence the antiviral response.